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AP: Cancer, MS Patients May Face Outrageous Costs Under ObamaCare

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Obamacare supporters react to the U.S. Supreme Court decision to uphold President Obama’s health care law, on June 28, 2012 in Washington, DC. (Photo: Getty Images)

Opponents of President Obama’s health care overhaul have long warned about the cost of the change, both on a national and personal level. But now, even the Associated Press is acknowledging that some of the most ill in our society– whom many thought would now have “free” or dramatically cheaper coverage– may be hit the hardest.

To try to keep premiums low, some states are allowing insurers to charge patients a hefty share of the cost for expensive medications used to treat cancer, multiple sclerosis, rheumatoid arthritis and other life-altering chronic diseases.

Such “specialty drugs” can cost thousands of dollars a month, and in California, patients would pay up to 30 percent of the cost. For one widely used cancer drug, Gleevec, the patient could pay more than $2,000 for a month’s supply, says the Leukemia & Lymphoma Society.

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A spokesman for Covered California said state officials are trying to balance between two conflicting priorities: comprehensive coverage and affordable premiums.

“We are trying to keep the insurance affordable across the board,” said Dana Howard, the group’s spokesman. “This is just part of trying to manage the overall risk of the pool.” [Emphasis added]

Dan Mendelson, the president of a data analysis firm catering to the health care industry and government called Avalere Health, has conducted research indicating that 1 in 4 cancer patients walk away from the pharmacy “empty handed” when faced with a bill of $500 or more — and presumably that number would only rise if the patient was faced with a bill of $2,000 a month.

The real-world result in this case, then, would mean more expensive coverage and dramatically less care.

But since heath care law gives states broad leeway to states to tailor benefits, costs will vary state-to-state. And whatever combination the states choose — higher costs for the average person to help pay for the sick, or higher costs for the sick to keep the cost lower for the average household — it’s very possible the administration will blame the states for the shortcomings, regardless of the position it put them in.

A Senate aide delivers federal regulations dealing with the Affordable Care Act, printed out and bound in red tape, for a debate on the budget in the Senate at the Capitol in Washington, Friday, March 22, 2013.

Though the Associated Press acknowledges that insurers are forecasting double-digit premium increases for individual policies, it is also quick to note that the Obama administration “says the industry warnings are overblown.”

California Covered’s Dana Howard further argued that consumers will be protected because the law limits total out-of-pocket costs – the deductibles and copayments that policy holders are responsible for, apart from monthly premiums. In California, the annual out-of-pocket limit for an individual is $6,400, although it can be as low as $2,250 for low-income people.

But that’s still a lot of money, and if you are a smoker, for instance, insurers are allowed to charge you up to 50 percent higher premiums. For a 55-year-old smoker, the penalty could reach nearly $4,250 a year, on top of the standard premium

“The intent of the Affordable Care Act is to make sure that all Americans have access to quality, affordable health care,” Brian Rosen, a senior vice president of the Leukemia & Lymphoma Society, said. He adds that there is a danger that the insurance marketplaces “will discriminate against the patients with the highest medical need. That would completely undermine the spirit of the ACA.”

Meanwhile, leukemia patient Lisa Lusk worries about what will happen to her. A nursing assistant who lives near Fresno, Lusk is hoping to return to work in the next few months. When that happens, she expects to lose emergency coverage she’s now getting through the state. And the medication Lusk takes to manage her chronic form of the disease costs more than $5,000 a month.

“I’m scared that when I get a job my copay may be more than $1,500 a month,” said Lusk. “I’ll just be working to pay for my medications.”